Komoda Takeshi, Komoda Satsuki, Dandel Michael, Weng Yuguo, Hetzer Roland
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum, Berlin, Germany.
J Card Surg. 2008 Nov-Dec;23(6):642-7. doi: 10.1111/j.1540-8191.2008.00665.x.
Myocardial recovery in patients supported by the INCOR left ventricular assist device (LVAD; Berlin Heart GmbH, Berlin, Germany) is seen in 5% of patients on this device worldwide. We describe improved surgical techniques for INCOR LVAD explantation.
The outcome of INCOR LVAD implantation at our center and the operative techniques of device explantation were studied. The patients weaned from the device were followed up.
Out of 121 patients supported by the device, five (4.1 %) were weaned from the device, whereas 34 patients (28.1 %) underwent heart transplantation. In explantation surgery, the inflow cannula was removed (one case) or remained in the left ventricle after occlusion with an inflow cannula plug, with transection of the inflow cannula at its curve (two cases) or without transection (two cases). When the inflow cannula was occluded without the support of cardiopulmonary bypass (two cases), operative time (180 min and 210 min) was shorter than that with other explantation procedures. After mean follow-up of 2.4 years (range two months-four years) after device explantation, all five patients are alive, have not required heart transplantation and are in New York Heart Association class I (one case) or class II (four cases). After weaning from the device, no cerebrovascular complication was observed in any of the five patients.
There is a possibility of weaning after INCOR implantation and surgical techniques for the removal of the INCOR LVAD should be further developed.
在全球范围内，接受INCOR左心室辅助装置（LVAD；德国柏林柏林心脏有限公司）支持的患者中，有5%出现心肌恢复。我们描述了改进的INCOR LVAD植入手术技术。
研究了我们中心INCOR LVAD植入的结果以及装置移除的手术技术。对脱离该装置的患者进行了随访。
在121例接受该装置支持的患者中，5例（4.1%）脱离了该装置，而34例患者（28.1%）接受了心脏移植。在植入物移除手术中，流入插管被移除（1例），或在使用流入插管封堵器封堵后留在左心室，流入插管在其弯曲处被切断（2例）或未被切断（2例）。当在没有体外循环支持的情况下封堵流入插管时（2例），手术时间（180分钟和210分钟）比其他植入物移除手术短。在装置移除后平均随访2.4年（范围为2个月至4年），所有5例患者均存活，无需进行心脏移植，纽约心脏协会心功能分级为I级（1例）或II级（4例）。在脱离该装置后，5例患者中无一例出现脑血管并发症。
INCOR植入后有可能脱离装置，应进一步开发移除INCOR LVAD的手术技术。
